Dermatology Flashcards

1
Q

differentiating vitiligo from pityriasis versicolor?

A

Vitiligo-depigmentation
Pityriasis versicolor-hypopigmentation

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2
Q

What is erythema multiforme major?

A

Erythema multiforme is an acute, immune-mediated skin condition that typically presents with target-like lesions on the skin and mucous membranes (eyes and mouth). This condition can be triggered by infections (commonly herpes simplex virus or mycoplasma pneumoniae) or medications.

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3
Q

Describe seborrhoeic dermatitis?

A

Seborrhoeic dermatitis in adults is a chronic dermatitis thought to be caused by an inflammatory reaction related to a proliferation of a normal skin inhabitant, a fungus called Malassezia furfur (formerly known as Pityrosporum ovale).

Causes itchy rash affecting the head : scalp (may cause dandruff), periorbital, auricular and nasolabial foldsdistribution is commonly caused by seborrhoeic dermatitis, causes ill-defined, pink coloured patches with a yellow/brown scale.

If untreated can lead to blepharitis and otitis externa

the first-line treatment is ketoconazole 2% shampoo

AKA as cradle cap in children - not normally itchy for them

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4
Q

What is the management of psoriasis?

A

regular emollients always

first-line:
steroid + vit D analogue (separate) OD

second-line: no improvement after 8 weeks - vitamin D analogue BD

third-line: if no improvement after 8-12 weeks then offer either: a potent corticosteroid twice daily for up to 4 weeks, or a coal tar preparation applied once or twice daily

In secondary care: phototherapy, biological agents

Topical Vit D (calcipotriol) can be used for long term mx of psoriasis if needed

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5
Q

How do you treat Pityriasis versicolor? what causes it?

A

topical antifungal.- ketoconazole shampoo/ selenium sulphide shampoo/ top imidazole cream
melassezia furfur

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6
Q

Superifical spreading vs nodular vs lentigo vs acral melanoma types?

A

superficial: most common, typically flat patch of pigmented skin which grows slowly. It can be recognised by an ABCDE approach. Younger people.

Nodular: 2nd most common. Older people. Red or black lump or lump which bleeds or oozes

Lentigo:elderly, slow growing

Acral: Nails, palms or soles, People with darker skin pigmentation. Hutchinsons sign (nail)

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7
Q

What is the name of the rash that appears in lyme disease?

A

Erythema chronicum migrans (‘bulls-eye’) rash occurs in around 80% of patients with Lyme disease

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8
Q

What is the mx of acne?

A

Mild: combination of two: topical abx (clina/ erythro) +/- topical benzoyl peroxide +/- topical retinoid (tretinoin, adapalene)

moderate to severe acne:
Topical retinoid/ benzoyl peroxide/ azelaic acid + PO abx (doxy) or COCP for women

Topical and oral antibiotics should not be used in combination!!!

severe acne: extensive inflammatory lesions, which may include nodules, pitting, and scarring
oral isotretinoin: started by specialists only

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9
Q

What rashes are associated with reactive arthiritis?
How is reactive arthirtis mx?

A

circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

NSAIDS
sulfasalazine and methotrexate are sometimes used for persistent disease

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10
Q

What is Pityriasis rosea

A

May be proceded by viral infection
herald patch (usually on trunk)
followed by erythematous, oval, scaly patches which follow a characteristic distribution with the longitudinal diameters of the oval lesions running parallel to the line of Langer. This may produce a ‘fir-tree’ appearance

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11
Q

Mx of rosacea?

A

mild-to-moderate papules and/or pustules:
topical ivermectin 1st line
alternatives include: topical metronidazole or topical azelaic acid

moderate-to-severe papules and/or pustules:
topical ivermectin + oral doxycycline

Steroids are CI!!! can make worse

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12
Q

describe a dermatofibroma?

A

common, benign, fibrous nodule. Well defined, symmetrical, one colour.
dimple sign = dimples when it is pinched
may form in relation to trauma such as insect bites.
These lesions are often asymptomatic but may be associated with mild pain or itch.

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13
Q

How do you differentiate between bullous pemphigoid or pemphigus vulgaris?

A

Both blisters/bullae

Tense blisters (deeper location) no mucosal involvement: bullous pemphigoid (avOID = NO mucosa)

flaccid blisters + mucosal involvement: pemphigus vulgaris (US = includes mucosa)

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14
Q

What condition causes hair loss in localised regions with no scarring/ itching?

A

Alopecia areata

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15
Q

Features of rosacea?

A

flushing of nose/ cheek/ forehead, pustules, Rhinophyma (bulbous nose), blepharitis, telangectasia
NOT itchy

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16
Q

What rash is associated with coeliacs?

A

Dermatitis herpetiformis
itchy, vesicular skin lesions on the extensor surfaces

17
Q

tinea corporis vs erythema multiforme

A

tinea has single well-demarcated, erythematous circular patch with a raised edge and central hypopigmentation. Caused by fungal infections eg trichophyton, microsporum, epidermophyton

Erythrema multiforme has multiple separate spreading rings and usuallys viral cause/ drug cause, target lesion, mucosal involvement

18
Q

vs SJS vs Toxic epidermal necrolysis (TEN) vs Staphylococcal Scalded Skin syndrome (SSSS)

A

TEN:
>30% body surface
Often triggered by meds eg anti-epileptics, abx, allopurinol, NSAIDs
extensive detachment of the epidermis, leading to the formation of large fluid-filled blisters that easily separate upon pressure. (+ve nikolskys)
Can cause AKI

SJS
<10% body area, like TEN but less severe

SSSS:
Mostly children.
Not drug cause

19
Q

How urgently should you refer a BCC?

A

routine UNLESS eyes/ nose where further damage may occur

20
Q

What is the hutchinsons sign in shingles?

A

herpes zoster: This is Hutchinson’s sign which is strongly predictive for ocular involvement - nasociliary pathway of trigeminal nerve (can lead to anterior uveitis). rash @ tip of nose

21
Q

Mx of keloid scars?

A

early keloids may be treated with intra-lesional steroids e.g. triamcinolone

22
Q

What is pompholyx eczema?

A

Pompholyx, also known as dyshidrotic eczema, usually presents with small fluid-filled blisters/ vesicles on the palms of hands or soles of feet –> dry sesquamating phase

Flares up in heat/ humidity

23
Q

What causes Kaposis sarcoma?

A

Human herpes virus 8

24
Q

What is necrobiosis lipoidica?

A

Middle aged women with diabetes typically
bilateral erythematous plaques on shin with telangectasia
Yellow hue due to lipids deposition
may be asx/ itchy/ tender

25
Drug causes of erythema multiforme?
penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine
26
Stevens- johnson vs toxic epidermal necrolysis? vs erythema multiforme
erythema multiforme- target lesions, no blisters, less likely mucosal involved both below are drug reaction and mucus membranes, blistering SJS - rash affecting <10% of body surface area Toxic epidermal necrolysis at least 30% of body surface area
27
What is palmoplantar pustulosis?
Fluid filled blisters on palms and feet - similar to pompholyx but is associated with psoriasis anf smoking and not associated with heat/ humidity
28
What adverse effect can topical corticosteroids cause on dark skin?
patchy depigmentation
29
What are the different causes of alopecia?
Scarring: trauma, lichen planus, sicoid lupus, tinea capitis Non-scarring: male-pattern baldness drugs: cytotoxic drugs, carbimazole, heparin, oral contraceptive pill, colchicine nutritional: iron and zinc deficiency autoimmune: alopecia areata telogen effluvium hair loss following stressful period e.g. surgery trichotillomania
30
Face flexural and genital psoriasis management
, Outline NICE recommend offering a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks
31
Pemphigoid gestationis vs Polymorphic eruption of pregnancy vs Atopic eruption of pregnancy
Pemphigoid gestationis- blisters, starts peri-umbilical region, 2nd/ 3rd trimester, need PO steroids Polymorphic eruption of pregnancy- last trimester, starts as abdo striae, treat with steroids (PO/ top) and emollients Atopic eruption of pregnancy- most common, like eczema
32
Mx of urticaria?
1st line if can avoid trigger, do this If sx need addressing then non-sedating antihistamines eg cetirzine 10mg OD, fexofenadine 180mg OD, loratidine 10mg OD - can increase up to QDS Consider montelukast Consider sedating antihistamine if can't sleep calamine lotion or topical menthol 1% in aqueous cream if itchy skin if severe use steroids - prednisolone 40mg OD 7 days
33
Presentation of discoid lupus?
on sun exposed areas leave pigmented/ hypopigmented skin treat with PO steroids/ fluconide cream
34
What is ringworm also known as?
dermatophytosis
35
Mx of actinic keratoses?
Options include: Topical 5FU (5 fluoracil) topical diclofenac - ONLY if mild cryotherapy if only a few lesions fluorouracil with salicylic acid Imiquimod if above above can't be used
36
BCC vs SCC
BCC - slow growing, translucent pearly bump with telangectasia , may later have central ulceration SCC-rapidly growing, painless, ulcerate nodules may have a cauliflower-like appearance (keratinised), may be bleeding
37
What is a keratocanthoma?
Keratocathoma = dome shaped volcano, with central depression
38
Mx of male pattern baldness?
options are wigs, finasteride / minoxidil, surgery not available on NHS
39
Mx of guttate psoriasis?
reassurance, only treat if sx